Oxford Textbook of Cardiothoracic Anaesthesia

In comparison with many other areas of medicine, cardiothoracic

anaesthesia is a relatively young speciality, underpinned by several

historic innovations in a little over 100 years. The first step to

overcome was the pneumothorax problem, conquered at the end

of the nineteenth century. Other major advances occurred with

developments in cardiopulmonary bypass (CPB), lung isolation,

intraoperative transoesophageal echocardiography (TOE), and

mechanical support for the failing heart. These successes aside,

the evolution of cardiothoracic anaesthesia has, at times, wandered

down some blind alleys and several misconceptions held

back progress. For this reason, and to place contemporary practices

in context, we begin in the first chapter with a review of the

history of cardiothoracic anaesthesia, including the errors, lest we

be condemned to repeat the mistakes of the past.

Editing this book has given us pause for thought in regard to the

knowledge and skills, over and above those of a specialist anaesthetist,

that are necessary for the subspecialty of cardiothoracic

anaesthesia. As a distillation of that thought, this textbook aims

to provide the theoretical knowledge required to inform optimum

clinical practice. Where possible, this has been done using an

evidenced-based approach but not to the detriment of undervaluing

extensive clinical experience. Cardiothoracic surgery is now

routinely performed around the world and there is a universal

need for subspecialty training in cardiothoracic anaesthesia. We

are therefore delighted that, in addition to an international editorship,

authors of renown from around the world accepted our

invitations to write chapters for this textbook.

Whilst in the past too much importance may have been placed

on physiological and other surrogate measures rather than true

patient-centred outcomes, a sound knowledge of the basic sciences

underpinning our speciality remain essential to current practice

in cardiothoracic anaesthesia. Additionally, the specific problems

in haemostasis and coagulation related to cardiac surgery make

this field an optimal playing ground for point-of-care monitoring

of the haemostatic system. Therefore, we have included chapters

on the relevant anatomy, physiology, pathophysiology, and pharmacology,

and consideration is given to inflammation, hypothermia,

coagulation, anticoagulation, and transfusion medicine